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Symptoms & Supports

PANS/PANDAS in the School Setting - Symptoms & Supports

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There are no set guidelines for supports and accommodations for students with PANS/PANDAS within the school setting. PANS/PANDAS is not a "one size fits all" medical condition therefore individualized support is required. Most students with PANS/PANDAS are eligible for accommodations and supports under a 504 plan if the medical condition substantially hinders the student’s ability to participate and manage the education curriculum. Individualized Education Plans (IEPs), under the Individuals with Disabilities Act (IDEA), are required for some students with PANS if special education and/or special services are warranted. Every child with PANS/PANDAS has different severity of symptoms and dissimilar symptoms from one student to the next. For most, school is difficult and requires appropriate accommodations and supports.  Some children are too sick to attend school and will require home bound instruction.

More NEPANS Resources
School Resources
Signs of PANS @School
School Nurses & Health Care Plans
Excused Absences & Home Bound Laws

PANS/PANDAS Fact Sheets

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Image Credit:Designed by Freepik

“therapy can be instrumental in negotiating exacerbation, but doing so requires a paradigm shift. Children often lose skills during exacerbation, and traditional remedial intervention may be ineffective. Greater benefit may be found with adaptation and compensation for problems during exacerbation, followed by remediation of ongoing problems during remission.”

PANDAS: A New Frontier for Occupational Therapy Intervention - Janice Tona & Trudy Posner


PANS/PANDAS - Symptoms @ School & Accommodations

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One Page PDF - How PANS Symptoms Manifest in School
PANS Symptoms @School
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Manifestation of PANS Symptoms & Supports/Accommodations
Symptoms & accommodations
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OCD at School
OCD at School b/w

Manifestation of PANS Symptoms in the School Setting
BEHAVIORAL Symptoms
•Obsessive Compulsive Disorder
•Obsessive Thinking (Inappropriate Thoughts/Rigid Thinking/Perfectionism)
•Eating Issues (Limited Menu/Fear of Choking/Anorexia)
•Anxiety (Separation Anxiety/School Refusal)
•Aggression (Defiance/Rages)
•Age Regression/Immaturity (Tantrums/Baby Talk)
•ADHD (Fidgeting/Outbursts/Poor Impulse Control)
•Sensory Issues  
ACADEMIC Symptoms
•Loss of Math Skills
•Decline in Handwriting Skills (Dysgraphia)
•Unable to Make Simple Decisions
•Poor Short-Term Memory
•Decline in Creative Work (Art, Creative Writing)
•Avoidance of High Sensory Environments (Art, Music, Cafeteria, Physical Ed, etc…)
•Loss of Focus on a Single Task
•Work Refusal (School Work, Homework etc)
•Perfectionism (Erasing thru paper, starting over)
PHYSICAL Symptoms
•Tics (Motor/Vocal)
•Eye Issues (Dilated Pupils, Vision Issues, Hallucinations)
•Eating Issues (Limited Menu/Fear of Choking/Anorexia)
•Frequent Urination (Trips to the Bathroom)
•Unusual Gait
•Balance Issues
•Chapped Hands or Lips/Mouth
•Trichotillomania (Hair Pulling/Skin Picking)
•Enuresis
EXECUTIVE FUNCTION Symptoms
•Difficulty with Working Memory and Holding Information
•Poor Organizational Skills
•Time Management Issues
•Difficulty Planning/Prioritizing Attention on a Single Task
•Difficulty Making Decisions

Basic School Supports
Student needs and performance may vary widely from week to week.
  • Behavioral & Sensory supports
  • Reduce student’s stress.
  • Plan for acute symptom exacerbation.
  • Plan for periods when less intensive supports are needed.
  • Homework Accommodations
  • Plan for frequent absences and tardiness.
  • Encourage student to avoid germs, clean tables, wash hands, etc
Communication Supports
Students benefit from strong and proactive school communication. Creating a IHCP - Individual Health Care Plan can help ensure these supports are in place and enforced.  (Read More for Sample IHCP)
  • Report any abrupt changes in behavior, eating habits, or school performance to family.
  • Inform parents of any communicable illness in classrooms.
  • Parents will inform school nurse of any health changes

Supports & Accommodations for different symptoms
OCD
•Compulsions:
       ~Alter Work Sequence/ Alternative Schedule if stuck on section or task
       ~ID & Substitute less disruptive behaviors
       ~Timer to signal transitions
       ~If child is continually erasing work, allow computer
       ~Safe Space to release compulsion during day
•Obsessions:

        ~Allow “interrupter” when in rut ie snapping band on wrist
        ~ID special words/prompts for teacher to interrupt obsessions
        ~Goal for curbing repetitive questioning
•Group Activities: 
Allow separate set of materials
•Allow early class dismissal to avoid crowds in hallways
•Allow spell check/calculator to be used one time at end in case of anxiety/perfectionism
Anxiety
•Relaxation Techniques
•Safe Space – Safe Person
•Cool Down Pass
•Class Participation: fears range from inaccuracy to being looked at by peers-consider starting with close-ended questions or opinion questions.
Signal child that it is almost their turn. Exempt participation as needed.
•Class Presentations: Reports can be given to teacher alone or videotaped at home.
•Testing: Extended time. Alternate testing location if anxiety increases by watching other kids turn in work quickly
Mood Changes
•Calming Techniques
•Safe Space – Safe Person: ID 1 person to check in with for 5-10 minutes to ease mood changes to enable the return to class.
•Cool Down Pass to allow child to leave situation briefly. Use a card to signal teacher so child does not become center of attention
Sensory
•Sensory Supports: pressure, weighted vests, proprioception
•Sensory Seeking: varying tactile input
•Sensory Defense: low light, quiet space
•Allowing hats to be worn in class if needed to apply pressure to head or shield from lighting
ADHD
•Extended Time
•Frequent Breaks
•Exercise Breaks
•Redirection
•Written Directions
•Preferential Seating: close to teacher, away from window/door
•Fidget Toys
•Testing: Extra/Unlimited Time, Separate testing location if needed
•Lighter homework load
• Alarm Reminders to keep student on task
Organization
•Assignment Planner: Weekly layout, keep pen with it, clip current week
•Homework Binder with log for parents to communicate with teacher
•Graphic Organizer & Outlining Programs
•Long Term School Projects: Break down into segments with separate goal dates (topic selection, research, outline, first draft, final draft)
•Color Code Subjects
•Extra Set of Books for home use
•Buddy to help take notes
•Schedule time to clean desk/locker
Memory
•Management: Lists, Timers, Calendars
•Repetition of Information
•Review Time
•Recording devices
•Provide lecture notes/outline
Dysgraphia
•Keyboard/Assistive Technology
•Built-Up pencils
•Graph paper/raised line paper
•Grade work on content rather than neatness
Math Regression
•Math Facts, Formula Sheets, Calculator
•Extended Time
•Shortened Assignments
•Manipulatives
Language Issues
•Extra Time
•Assisted Technology
•Speech Therapy
Fatigue
•Time to rest.
•Healthful snack
Mobility Issues
•Adaptive PE
•Physical Therapy
•Field Trip accommodations/support
Urinary Frequency
•Low Key Bathroom Access
•Tracking

Lateness
•Late slip on file
•Temporary later start time
Tics
•Nurse Breaks
•Reading/Writing: Assistive Technology and allow oral Responses
•Vocal Tics: Less reading aloud.
•Testing Modifications
 

Additional Resources

General Resources
Little known disorder underscores education needs
By Patricia Rice Doran  (Baltimore Sun-2014)
Read More

Families’ Experiences with PANDAS and Related Disorders
by Patricia Rice Doran of Towson University presented at the Council for Exceptional Children 2015 annual convention.
Read More

Considerations Regarding Academic Accommodations/Compensatory Strategies, and Services for Students with PANDAS/PANS
Jamie Candelaria Greene PhD, BCET
Read More at PandasNetwork

Pediatric Autoimmune Neuropsychiatric Disorders: A New Frontier for Occupational Therapy Intervention
Trudy Posner & Janice Tona
Read More

PANDAS School Daze Series: Back to School Lessons

Read More at PANDAS Sucks Blog

Letters to School
Letter Requesting Notification of Strep Exposure from Classmates
Read More at PandasNetwork

Letter to School while in PANDAS Exacerbation
Read More at PandasNetwork

Letter to School while in Remission
Read More at PandasNetwork

Image Credit: Designed by Freepik
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  • About Us
    • Mission & History
    • Our Board
    • NEPANS Newsletter
    • Contact Us
  • PANS/PANDAS Info
    • Before/After PANS - Examples
    • PANS/PANDAS Symptom Severity
    • OCD
    • PANS/PANDAS Rating Scales/Tracking Tools
  • Resources
    • PANS Information pdfs
    • Awareness Posters
    • PANS Family Stories
    • Websites/Studies/News >
      • JCAP-Treatment Guidelines & Consensus Paper
      • Research, Studies, Journals
      • Web Articles & Fact Sheets
      • In the News
    • School Resources >
      • Symptoms & Supports
      • Before/After PANS Examples
      • Nurses & Health Care Plans
      • Absences & Homebound
    • Video Library
  • Events
    • Upcoming Events >
      • Outreach Events - Presentation, Tables, Information
    • Past Events >
      • Reaching Recovery Evening
      • NEPANS Integrative Medicine Conference
      • CEC Convention
      • My Kid Is Not Crazy
      • Lecture Series
      • Family Events
      • Family Picnic w PANS Life
      • CT Conf-2014
      • NH Conf-2014
      • Dr's Breakfast-14
      • Parent's Q&A-14
      • RI Conference-2013
      • NEPANS Supported Events
    • Speaker Bios
    • Support Groups
  • Get Involved
    • PANS PANDAS Awareness Day >
      • 2019 Awareness Day
      • 2017 Awareness Day
      • 2016 Awareness Day
      • 2015 Awareness Day
      • 2014 Awareness Day
      • 2013 Awareness Day
    • Spread Awareness
    • Legislative News >
      • CT Legislative News
      • MA Legislative News
      • NH Legislative News
  • NEPANS Blog